- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.53 / $37.22 / $47.78
| Professional | | $31.53 | $37.22 | $47.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.82 / $36.01 / $69.52
| Professional | | $23.82 | $36.01 | $69.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $29.82 / $44.47 / $85.42
| Professional | | $29.82 | $44.47 | $85.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $357.52 / $368.25 / $368.25
| Professional | | $357.52 | $368.25 | $368.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $26.78 / $34.17 / $45.18
| Professional | | $26.78 | $34.17 | $45.18 |